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Geriatric Patient Outcomes of Major Burn due to High-Voltage Electrical Injury: A Case Report
Vincent Anggriant, Ratna Rayeni Natasha Roosseno, Daniel Puguh Pramudyo, Yoseph ChandraOnline First: Sep 22, 2022
- Abstract
Geriatric Patient Outcomes of Major Burn due to High-Voltage Electrical Injury: A Case Report
Introduction: Electrical burns are uncommon but result in high morbidity and mortality due to severe tissue damage. Geriatrics are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defence mechanisms and reduced mobility. A high-voltage electrical injury has complex complications, especially long-term complications. This study aimed to present the case of geriatric patient outcomes of major burn due to high-voltage electrical injury.
Case Presentation: This is a case report of electrical burn injuries; a 70 years old man came to the emergency room approximately 1 hour after the incident, and a chief complaint was burning due to electrical shock. The patient had a history of electrical shock when fishing on the side of the river bank, where there is a high-voltage electrical central behind him. When he threw his fishing line, the fishing line caught on the exposed high-voltage transformer cable causing an electric shock. The examination showed that the patient was conscious of burns on the right chest to the abdomen and palm to the right hand, as well as on both soles of the feet. Another complaint was a pain in the wound due to electrical shock without a history of fainting, shortness of breath, chest pain, headache, and vomiting. The patient’s previous medical history showed uncontrolled hypertension.
Conclusion: Our study demonstrates a rare geriatric patient discharged without complications due to a high-voltage injury. Strict multi-specialty management and rehabilitation are required to treat electrical injuries properly.
Alopesia universalis pada anak yang berespon baik dengan terapi kombinasi: sebuah laporan kasus
I Gusti Ayu Agung Praharsini, I Gusti Ayu Agung Dwi Karmila, Ratih Purnamasari Nukana, Henny WijayaOnline First: Sep 19, 2022
- Abstract
Alopesia universalis pada anak yang berespon baik dengan terapi kombinasi: sebuah laporan kasus
Background: Alopecia universalis is an autoimmune disease of the hair follicles, which results in complete loss of head and body hair. Until now there is no proven effective therapy in dealing with this disease. We report a case of alopecia universalis that responded well to combination therapy.
Case: Female, 22 months old, complained by her parents due to hair loss on her head, eyebrows and eyelashes that had not grown back since the age of 8 months. On the fingernails and toenails found pitting nails, trachonycia. On scalp dermoscopy examination, multiple yellow dots were found. Severity of Alopecia Tool Score (SALT) was 100%. The patient was treated with minoxidil 5%, mometasone 0.1%, triamcinolone 12 mg and excimer laser. Administration of minoxidil increases prostaglandin production and maintains the anagen phase. Corticosteroids are immunosuppressive which suppress the immune attack of T cells on hair follicles. UV light on the excimer laser can reduce the proliferation of T lymphocytes, thereby reducing perifollicular inflammation and hair follicle damage. In this case, after 4 months of observation, the growth of terminal hair and vellus hair on the scalp, eyebrows and eyelashes was seen. On the patient's nails, the trachonycia was improved, with pitting nails remaining. SALT decreased to 58%.
Conclusion: The combination therapy of minoxidil, corticosteroid and excimer laser gave good results in this case. During treatment, there were no side effects or recurrences.
Latar belakang : Alopesia universalis adalah penyakit autoimun pada folikel rambut, yang mengakibatkan kerontokan seluruh rambut kepala dan tubuh. Hingga saat ini belum ada terapi yang terbukti efektif dalam menangani penyakit ini. Berikut dilaporkan kasus alopesia universalis yang memberikan respon baik dengan terapi kombinasi.
Kasus: Pasien perempuan, 22 bulan, dikeluhkan orang tuanya mengalami rambut kepala, alis dan bulu mata yang rontok dan tidak tumbuh kembali sejak usia 8 bulan. Pada kuku tangan dan kaki didapatkan adanya pitting nails, trachonycia. Pada pemeriksaan dermoskopi kulit kepala didapatkan adanya multiple yellow dots. Severity of Alopecia Tool Score (SALT) 100%. Pasien diberikan terapi minoksidil 5%, mometason 0.1%, triamsinolone 12 mg dan laser excimer. Pemberian minoksidil meningkatkan produksi prostaglandin dan mempertahankan fase anagen. Kortikosteroid bersifat imunosupresif yang menekan serangan imunitas sel T pada folikel rambut. Sinar UV pada laser excimer dapat menurunkan proliferasi sel T limfosit sehingga mengurangi peradangan perifolikular dan kerusakan folikel rambut. Pada kasus, setelah pengamatan selama 4 bulan nampak adanya pertumbuhan rambut terminal dan rambut vellus pada kulit kepala, alis dan bulu mata. Pada kuku pasien nampak trachonycia membaik, tersisa pitting nails. SALT menurun menjadi 58%.
Simpulan: Terapi kombinasi minoksidil, kortikosteroid dan laser excimer memberikan hasil yang baik pada kasus ini. Selama pengobatan tidak didapatkan adanya efek samping dan rekurensi.
Personal hygiene genitalia wanita
Made Hermina Laksmi, Ni Made Dwi Puspawati, Aurelia Stephanie, Putu Gde HariwangsaOnline First: Sep 19, 2022
- Abstract
Personal hygiene genitalia wanita
Since the beginning, genital hygiene has become a concern for women susceptible to infections of the urinary tract and reproductive system where the vagina is an unsterile organ related to external exposure and close to the anus. Several problems related to the personal hygiene of female genitalia arise due to a lack of understanding and literature discussing this matter. This literature review will discuss the normal flora of the female genitalia and procedures for daily vaginal care, which aims to increase understanding of female genital personal hygiene.
Sejak dahulu hygiene genetalia sudah menjadi perhatian kaum wanita, karena wanita sangat rentan terkena infeksi traktus urinarius dan sistem reproduksi dimana vagina merupakan organ yang tidak steril yang berhubungan dengan dunia luar serta berdekatan dengan anus. Beberapa masalah terkait personal hygiene genitalia wanita timbul akibat kurang pemahaman dan sedikitnya literatur yang membahas tentang hal ini. Tinjauan pustaka ini akan membahas mengenai flora normal genitalia wanita dan tata cara perawatan vagina sehari-hari yang bertujuan untuk meningkatkan pemahaman terhadap personal hygiene genitalia wanita.
Kadar Urine Urea Nitrogen (UUN) sebagai prediktor mortalitas pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah Denpasar
Grace Inriani Rongre, I Gusti Putu Hendra Sanjaya, Agustinus I Wayan Harimawan, Sianny HerawatiOnline First: Sep 21, 2022
- Abstract
Kadar Urine Urea Nitrogen (UUN) sebagai prediktor mortalitas pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah Denpasar
Background: Urine urea nitrogen (UUN) is an examination of nitrogen balance with the concept of calculating the amount of urea excreted through urine. The amount of urea that comes out of the urine is in line with the amount of protein breakdown in the body and the amount of protein that enters the body. This study aimed to evaluate UUN levels on days 1, 3 and 7 as a predictor of mortality in burn patients >20%.
Methods: This study was an observational analytic retrospective study. Data were collected from January 2020 to December 2021. This study used secondary data from medical records of patients with IIAB-III degree burns with burn area > 20% TBSA treated at Prof. Dr. I. G. N. G. Ngoerah General Hospital for 2020-2021. Data were analyzed using SPSS version 21 for Windows.
Results: The majority of burn patients were male, about 73.9%. The average age of burn patients is 48.26±15.95 years. On the first examination day, the UUN value was still low (29.4 mg/24 hours). Then on the 3rd day, there was an increase in the average UUN level, namely the maximum value of 61,987 mg/24 hours. Examination on the 7th day showed an increase in line with the previous day, namely the maximum value of 57,489 mg/24 hours. On day 1, the mean UUN value was higher in patients who died, while on days 3 and 7 the mean UUN level in patients with living outcomes was higher than in patients who died, but not significantly (p>0.05).
Conclusion: Urine urea nitrogen levels on days 1, 3 and 7 in burn patients >20% at Prof. Dr. I. G. N. G. Ngoerah General Hospital showed an increasing trend. Urine urea nitrogen levels cannot be used to predict mortality in burn patients because the results were insignificant.
Latar Belakang: Urin urea nitrogen (UUN) merupakan pemeriksaan keseimbangan nitrogen yang berkonsep pada perhitungan jumlah urea yang dieksresikan lewat urin. Jumlah urea yang keluar bersama urine sejalan dengan jumlah pemecahan protein dalam tubuh serta jumlah protein yang masuk dalam tubuh. Penelitian ini bertujuan untuk mengevaluasi kadar UUN hari ke-1,3, dan 7 sebagai prediktor mortalitas pasien luka bakar >20%.
Metode: Studi ini merupakan studi retrospektif analitik observasional. Data dikumpulkan dari Januari 2020 hingga Desember 2021. Studi ini menggunakan data sekunder dari catatan rekam medis pasien luka bakar derajat IIAB-III dengan luas luka bakar > 20% TBSA yang dirawat di RSUP Prof. Dr. I. G. N. G. Ngoerah periode 2020-2021. Data dianalisis dengan SPSS versi 21 untuk Windows.
Hasil: Mayoritas pasien luka bakar berjenis kelamin laki-laki yaitu sebesar 73,9%. Usia rata-rata pasien luka bakar yaitu 48,26±15,95 tahun. Pada pemeriksaan hari pertama didapatkan nilai UUN masih rendah (29,4 mg/24 jam). Kemudian pada hari ke-3 didapatkan peningkatan rata-rata kadar UUN yakni nilai maksimum 61.987 mg/24 jam. Pemeriksaan pada hari ke-7 menunjukkan peningkatan yang sejalan dengan hari sebelumnya yakni nilai maksimum 57.489 mg/24 jam. Pada hari ke-1, nilai rerata UUN lebih tinggi pada pasien meninggal, sedangkan pada hari ke 3 dan 7 kadar rerata UUN pasien dengan luaran hidup lebih tinggi dibandingkan pasien yang meninggal, namun tidak bermakna secara signifikan (p>0,05).
Simpulan: Kadar UUN pada hari ke-1, 3 dan 7 pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah menunjukkan adanya trend peningkatan. Kadar UUN tidak dapat dipakai sebagai prediktor mortalitas pada pasien luka bakar karena hasil tidak signifikan.
